EP445 The ADNEX model to triage adnexal masses: an external validation study and comparison with the IOTA two-step strategy and subjective assessment by an experienced ultrasound operator

Introduction/Background The ADNEX (Assessment of Different NEoplasias in the adneXa) model was developed using parameters collected by experienced (level III) ultrasound examiners. Our primary aim was to externally validate the ADNEX model, when applied by level II examiners in an academic-women-hospital. The discriminatory performance of ADNEX was compared with the two-step strategy and subjective assessment by an experienced ultrasound operator. Methodology From February 2013 to January 2017, all patients who were scheduled for surgery for an adnexal mass at the Sant9Anna Hospital in Turin were enrolled. Preoperative transvaginal sonography was performed, and the two-step strategy was applied. Two ultrasound examiners applied the ADNEX model to all the collected masses based on the ultrasound reports. Finally, an experienced operator assigned the subjective assessment based on recorded ultrasound images. The discrimination and calibration performance of ADNEX were evaluated. The AUC was calculated for the basic discrimination between benign and malignant tumours Results A total of 577 patients were included in the analysis: the overall prevalence of malignancy was 25%. With ADNEX, the AUC to differentiate between benign and malignant masses was 0.9111 (95% CI 0. 8788–0.9389). At risk cut-offs of 1%, 10% and 30%, sensitivities were 100%, 89.6% and 79.2%, respectively, and specificities were 2.8%, 76.2% and 89.6%, respectively. Discrimination between benign and stage II–IV tumours was good (AUC 0.935). The model had the most difficulties discriminating between borderline and stage I tumours, and between stages II-IV invasive and secondary metastatic tumours. ADNEX proved to be equally or more accurate than the subjective assessment or the two-step strategy in the discrimination between benign and malignant adnexal masses. Conclusion The ADNEX model could probably be successfully applied when a level III examiner is not available and, therefore both a subjective assessment and the two-step strategy cannot be performed. Disclosure Nothing to disclose.